Evaluation of I‐gel™ airway in different head and neck positions in anesthetized paralyzed children

• DOI: 10.1111/pan.12748
• Publication Date: 2015-09-18T12:38:57Z
• Authors: Divya Jain; Babita Ghai; Indu Bala; Komal Gandhi; Gargi Banerjee
• Keywords: Male; Infant; Respiration, Artificial; Laryngeal Masks; Patient Positioning; 3. Good health; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Child, Preschool; Intubation, Intratracheal; Fiber Optic Technology; Humans; Paralysis; Urologic Surgical Procedures; Female; Orthopedic Procedures; Anesthesia, Inhalation; Child; Head; Neck

SummaryBackgroundStudies that have compared and quantified the oropharynageal leak pressure (OPLP) and adequacy of ventilation with supraglottic airway devices in different head and neck positions have been done in adult populations. The effects of head–neck position changes on the functioning of I‐gel™ in pediatric population still remain unevaluated.AimThis study aimed to quantify the influence of different head and neck positions namely neutral, maximum flexion, and maximum extension on OPLP, ventilation scoring, and fiberoptic grading using I‐gel™ in anesthetized, paralyzed children.MethodsI‐gel™ was inserted in 30 paralyzed, anesthetized children scheduled for elective urological and orthopedic procedures. Anesthesia was induced with sevoflurane in oxygen. Atracurium was administered intravenously to facilitate neuromuscular relaxation. Recordings of OPLP in neutral, maximum flexion, and maximum extension were taken as primary outcome. Fiberoptic grading, insertion of ryle's tube and ventilation scoring were also measured in different head and neck positions as secondary outcomes.ResultsThe OPLP was significantly higher in flexion (27.6 ± 3.3 cm H2O, P = 0.000) and lower in extension (19.6 ± 3.2 cm H2O, P = 0.006) in comparison to the neutral position (23.2 ± 3.2 cm H2O). There was a worsening of the fiberoptic view in flexion compared to neutral position (0/5/19/6 vs 5/21/4/0). The ventilation score was poorer (1 [0–3], P < 0.05) and peak inspiratory pressures higher in flexion (15.2 ± 1.4 cm H2O, P = 0.000) compared to the neutral position (10.4 ± 1.6 cm H2O).ConclusionCaution is warranted in pediatric patients while ventilating with I‐gel™ in extreme flexion of head and neck owing to poor ventilation despite increase in OPLP.